S.A. hospitals do well, but no straight A's

By Don Finley - Express-News :
July 7, 2010

The federal government released new details Wednesday on the quality of emergency room and outpatient services at individual hospitals here and across the country. And while San Antonio hospitals as a group did fairly well, most had at least one area of concern.

Those details — ranging from whether patients were given recommended antibiotics before outpatient surgery to the proper use of MRIs for low-back pain — were added to the dozens of inpatient quality measures and patient satisfaction surveys already found at Hospital Compare, a 5-year-old website where patients and family can check up on their local hospital.

“Our goal here is not to label hospitals as good or bad, but it's to provide insight to the hospitals as well as the general public on what they are achieving in the care that they render,” said Dr. Barry Straube, chief medical officer for the Centers for Medicare and Medicaid Services, in a conference call with reporters. “Our ultimate goal is to achieve universally safe, effective and efficient care for all Americans, not just Medicare beneficiaries.”

Hospitals themselves use the information to compare their own safety and quality, Straube said. That seems to be the case in a continued drop in heart attack death rates nationwide. A three-year average death rate within 30 days of a heart attack fell from 16.6 percent to 16.2 percent from 2008 to 2009. Similar death rates for heart failure and pneumonia stayed the same.

Some of the new outpatient categories were a bit complicated to understand. One — how many patients got a second mammogram or ultrasound within 45 days of a screening mammogram — drew a caution from the president of the American Hospital Association. The government said the best hospitals tend to have a rate between 8 percent and 14 percent, indicating enough — but not too much — follow-up.

“These are frequency measures, and we want to be sure that we learn from them what the right number of follow-up images might be,” said AHA President Richard Umbdenstock. “And that is still an evolving science.”

Baptist Health System, University Hospital and Southwest General Hospital were less likely than the national average to give patients antibiotics within an hour of outpatient surgery to prevent surgical infections. Christus hospitals were less likely to give the correct antibiotic.

Leni Kirkman, a spokeswoman for the University System, said the widening use of electronic medical records will eventually improve those rates, as pop-up reminders on computers and even cell phones guide doctors through protocols and make it more likely they will make a note in the record when they follow those protocols — something they don't always do now.

In some areas, San Antonio hospitals did very well compared with their peers. Patients with chest pain got an electrocardiogram 43 minutes after arriving at the average U.S. hospital. In San Antonio, it was within one minute at Baptist hospitals, two minutes at TexSan Heart Hospital, and six minutes at Methodist.